Fear Depicted in Carnival of Souls

OCW2023: The Fear of Delivering Obesity Care

To be sure, fear of change is understandable. The number of people living with obesity and suffering its complications has grown large. Achieving a balance between treating a problem like obesity and preventing it is tricky. To make it worse, we are living in a time when the media has figured out that fear and rage are a keen way to keep people reading and clicking so they can sell advertising. Thus we find ourselves in this Obesity Care Week with some of the best options ever for treating obesity at the same time some loud voices are expressing a profound fear of delivering obesity care.

Philosophical Fears

Paul Terry is Editor in Chief of the American Journal of Health Promotion. In a new editorial, he describes a range of philosophical fears surfacing about obesity. They come in response to guidance for better treatment of obesity in pediatrics. Maybe we will do so clumsily, setting young persons up for lifelong problems with body image. So says an eating disorder specialist. She asks, how can we advocate for obesity treatment “when we’re not addressing things like poverty, food scarcity and housing instability?”

Terry points to others, like David Katz, who says that the real problem lies with the food industry:

“What we have is a food supply known to be willfully engineered to promote overeating; that is known to work exactly as intended; that is in turn known to induce weight gain, and thus foment rampant obesity.”

These folks are expressing fear and even rage that their philosophical priorities might not get attention.

Financial Fears

Meanwhile, we have the financial implications to consider. The cost of delivering medical care is soaring. The cost of obesity care is certainly not at the top of the list. But with limited coverage by health insurance, obesity care is only reaching the wealthy and the well-insured.

Health systems have elaborate schemes in place to ensure that this is true. The fear of paying for more obesity care is palpable, because obesity has grown to affect such a large number of people.

Scarcity of Care Is the Result

The scarcity of obesity care that results is a tragedy for the people who want and need it. We have the possibility to deliver better obesity care than ever before. But while we come to terms with our fears, health systems are denying that care to many people.

Obesity medicine physician Fatima Cody Stanford explains that we can do better:

“As someone who only believed in behavioral strategies prior to my training in obesity medicine, I can say that I failed many of my early patients.

“I’ve come to recognize the complexity of this disease and the need for evidence based treatment from various modalities from lifestyle, behavioral, medications, and surgery for pediatric patients with obesity. I’m thankful for the opportunity to care for patients across the age spectrum and ensure that they get a personalized treatment they need to treat the most prevalent chronic disease in human history – obesity.”

Terry explains that for such a complex problem, there is not a single right answer:

“Today’s obesity problem will not be solved with either/or thinking. There will be those who want to reframe obesity as something to be accepted and those who want to fight it with more aggressive treatment. Neither are wrong…or right.”

In the end, we have nothing to fear from better obesity care, except for the mistake of failing to provide it as needed.

Click here for Terry’s editorial.

Fear Depicted in Carnival of Souls, image from movie by Herk Harvey and John Clifford / Wikimedia Commons

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February 28, 2023